Purpose and scope
The purpose of this best practice guideline (BPG) is to provide an overview of principles, resources, and structures for delivering evidence-based supervised injection services (SIS).
This guideline is for
- nurses,
- health workers, and
- decision-makers on the most effective approaches for SIS delivery to people who inject drugs.
SIS should
- promote person engagement,
- support positive health outcomes and health equity, and
- reduce harms associated with injection drug use.
The main outcome of this guideline is to promote health equity for people who inject drugs through harm reduction, culturally safe, and trauma-informed practices and policies in SIS.
Registered Nurses’ Association of Ontario. Implementing Supervised Injection Services. Toronto (ON): Registered Nurses’ Association of Ontario; 2018
Recommendations
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Implementing Supervised Injection Services.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Recommendation 1.1: Develop trusting relationships based on respect and a non-judgmental approach at every encounter with people who inject drugs to support continued engagement.
Recommendation 1.2: Use reflective practice to recognize and acknowledge health inequities that result from past and ongoing experiences of trauma, marginalization, and stigma experienced by people who inject drugs.
Recommendation 1.3: Promote and engage in shared decision-making with people who inject drugs at every encounter and intervention to minimize discrimination and stigma.
Recommendation 2.1: Design educational programs that incorporate multiple teaching methods and strategies (in-person or technology-enabled) for health workers and students to increase knowledge, skill, confidence, and improve attitudes required to provide high-quality care to people who use drugs.
Recommendation 2.2: Incorporate people with lived experience and practice experts in the delivery of educational programs for health workers and students to increase knowledge and confidence, and improve attitudes required to provide high-quality care to people who use drugs.
Recommendation 2.3: Modify the format and structure of educational programs for health workers to support effective learning by focusing on
- location of training,
- resources required for training,
- frequency and longevity of training, and
- method of delivery.
Recommendation 3.1: Integrate peer workers into the programming of supervised injection services by
- increasing access to peer workers as a vital resource for people who inject drugs, and
- including peer workers in organizational decision-making processes.
Recommendation 3.2: Integrate comprehensive services into the programming of supervised injection services to ensure that people who inject drugs have access to
- testing and counselling for blood-borne infections,
- primary care providers,
- mental health clinicians, and
- housing and social services.
Recommendation 3.3: Embed harm reduction programs that include supervised injection services into existing health and social settings to improve retention in care and reduce adverse health outcomes among people who inject drugs.
Recommendation 3.4: Align the location, physical space, and operating hours of facilities to the needs of the local population, and make operational improvements and structural redesign (as needed) to decrease barriers for access to supervised injections services for people who inject drugs.
Recommendation 3.5: Advocate for legislation and regulations to support ethical policies and procedures that increase access to and utilization of supervised injection services for
- people who require assisted injection support, and
- youth who inject drugs.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.
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